Therapeutic Drug Monitoring: Chemical-Clinical Correlations of Atypical Antipsychotic Drugs

摘要

In the last few years, new drugs for the treatment of schizophrenia havenbeen introduced in therapy which have noticeably improved the quality of life ofnmany schizophrenic patients. These new “atypical” drugs have chemical,npharmacological and clinical properties which are different from those of the classicalnneuroleptics. The most used drugs among the “atypical” antipsychotics are clozapine,nolanzapine, quetiapine and risperidone. Despite several differences in theirnpharmacokinetic and pharmacodinamic profiles, they show some common properties:ne.g. they don’t cause extrapyramidal side effects, and they are active against the negativenas well as positive symptoms of schizophrenia.nThe need for clinical monitoring of patients undergoing therapy is still evident because the onset of sideneffects is often related to high plasma concentrations of the drug. The clinical monitoring of patients cannsignificantly improve the knowledge of pharmacological interactions among different CNS drugs, as well asnenhance the compliance of the patients, thus leading to higher treatment efficacy.nIn order to carry out efficient clinical monitoring, reliable analytical methods are needed to determine thenanalytes even at very low concentrations and in the presence of other drugs. For this purpose, analyticalntechniques such as gas or liquid chromatography are often used coupled with sensitive and selective means ofndetection, such as fluorimetric, electrochemical or mass spectrometry detectors. The most recent studies on thendetermination of atypical antipsychotics will be reviewed in addition to the issue of sample pretreatment whichnis a critical step when the analysis of biological fluids is concerned.